How Aetna Plans to Improve Quality of Care and Reduce Costs

Aetna: An Analysis of the Health Insurance Giant (Part 11 of 18)

(Continued from Part 10)

Transforming the network model

Aetna has adopted a strategy involving a combination of value-based payments and effective health technologies to transform its provider network. The company believes this strategy will improve the quality of care and also make it more cost optimal.

The above transformation strategy is implemented through Aetna’s Healthagen portfolio of businesses that increase the value, coordination, and transparency in the delivery of health care services. Healthagen comprises of ACS (Accountable Care Solutions), ActiveHealth, Medicity products, and other supporting services.

Accountable care solutions

Health insurance companies such as Aetna (AET), Humana (HUM), Cigna (CI), and UnitedHealth Group (UNH) are gradually shifting away from the fee-for-service payment model and are opting for value-based payment models to reimburse health care providers. These payment methods incentivize the providers to reduce the cost of providing medical services.

Aetna provides data analytics support to these providers to implement population management solutions. Population management solutions involve the use of technology to analyze patient data to create a complete clinical picture of every patient. This intelligence is then used to improve quality of care in a cost-optimal manner.

Data analytics

Aetna’s ActiveHealth Management and Medicity products form an important part of the company’s Accountable Care Solutions. ActiveHealth Management provides data analytics products and services to Aetna as well as other health insurance companies (XLV) and employers. Medicity, on the other hand, provides solutions to aggregate medical data and securely exchange it.

Supporting solutions

Aetna launched its WellMatch product in 2013, which improves the buying experience of people seeking health care services. WellMatch is an online platform where employers and individuals can compare prices of various health care providers, and can better manage their healthcare benefits and spending. Other products such as PracticeIQ and HDMS (Health Data Management System) also provide data-based solutions to improve care quality to physicians and other health providers.

Continue to Part 12

Browse this series on Market Realist:

• Part 1 - A Key Overview of Aetna, One of the Largest Insurance Providers

• Part 2 - What Are Aetna’s Key Business Segments?

• Part 3 - How Is Aetna’s Membership Distributed Across Its Key Markets?